Joseph Debattista

IMMUNOPATHOGENESIS OF CHLAMYDIA TRACHOMATIS INFECTIONS IN WOMEN

OBJECTIVE To develop a model of pathogenesis by which Chlamydia trachomatis progresses from acute to chronic infection, and finally serious disease (salpingitis, tubal occlusion). DESIGN Review of current literature located through web-based Medline searches using key words: Chlamydia trachomatis, immunology, cytokines, heat shock protein, infertility. RESULT(S) Cell-mediated immune mechanisms appear to be critical in determining whether acute infection is resolved or progresses into chronicity with pathological outcome. What determines the particular immune pathway depends on a range of determinants-HLA subtype and human genetics, cytokine profile, infectious load, route of infection, and endocrinology. A clearer picture of the natural history of chlamydial pathology may assist in providing better predictors of those women who may go on to develop significant sequelae after infection. CONCLUSION(S) Predicting those who may develop serious disease, including infertility, may contribute to improved management of such persons during earlier stages of infection and assist in prevention.

Reduced levels of gamma-interferon secretion in response to chlamydial 60 kDa heat shock protein amongst women with pelvic inflammatory disease and a history of repeated Chlamydia trachomatis infections.

Peripheral lymphocytes in uninfected fertile controls, women with various histories of Chlamydia trachomatis infection, pelvic inflammatory disease (PID) and infertility not due to C. trachomatis infection (endometriosis) were cultured overnight with PHA mitogen and the 60 kDa chlamydial heat shock protein. Plasma samples were then assayed for levels of gamma-interferon and IL-10 using a commercial ELISA system. Women with PID and those with a history of multiple C. trachomatis infections showed reduced gamma-interferon production in response to cHSP60, not seen in women infected only once and those with infertility due to other causes (endometriosis). Secretion of IL-10 in response to cHSP60 did not vary significantly across the various patient groups, though all patients showed elevated levels of total IL-10 compared with uninfected controls.

Screening for Neisseria gonorrhoeae and Chlamydia trachomatis at entertainment venues among men who have sex with men

Background To assess the prevalence and increase awareness of Neisseria gonorrhoeae and Chlamydia trachomatis infections among men who have sex with men, a screening program was conducted at three inner-city homosexual entertainment venues and one community function. Study Design Each venue was accessed twice over a 3-month period between March and June 2000. First-catch urine specimens were collected for analysis by polymerase chain reaction (PCR), and throat swabs were collected for culture and PCR. Results A total of 202 men were tested during the 7 screening nights, including 16 who were tested more than once. From the 186 men tested for the first time, 184 urine specimens were collected, of which 8 (4.3%; 95% CI, 1.9–7.8%) were PCR–positive for C trachomatis and 1 (0.5%; 95% CI, 0–2.1%) was PCR–positive for N gonorrhoeae. Of the 161 throat swabs collected, none were positive for C trachomatis or N gonorrhoeae. Conclusions C trachomatis is a potentially significant pathogen in this population of urban homosexual men. Screening programs such as these are valuable as health-promotion exercises.

Chlamydia trachomatis Serovars among Strains Isolated from Members of Rural Indigenous Communities and Urban Populations in Australia

ABSTRACT We genotyped Chlamydia trachomatis strains from 45 women or men living in either a rural indigenous community or in urban heterosexual communities. We found six different C. trachomatis serovars: E (n = 22; 48.9%), F (n = 10; 22.2%), J/Ja (n = 5; 11.1%), D/Da (n = 4; 8.9%), G (n = 3; 6.7%), and K (n = 1; 2.2%). The distribution of C. trachomatis serovars among members of the indigenous rural and the urban Australian communities appears similar to that in other Western countries.

Sexually transmissible infections among sex workers and their clients: variation in prevalence between sectors of the industry

OBJECTIVES The risk of sexually transmissible infection (STI) among sex workers and their clients may be higher than the general population. However, many studies have categorised workers or clients into homogenous groups for the purposes of analysis. The aim of the present study was to assess variations in self-reported STI rates among licenced brothel, private and illegal sex workers and their clients. METHODS In 2003, self-report data were collected from female sex workers and their male commercial clients residing in the state of Queensland, Australia. Overall, 247 sex workers (aged 19-57 years) and 185 of their respective clients (aged between 19 and 72 years) completed anonymous questionnaires. RESULTS There was little variation in self-reported lifetime STI prevalence of licenced brothel, private and illegal (predominantly street-based) sex workers, although licenced brothel workers were less likely to report ever being diagnosed with gonorrhoea or pubic lice in the past (P = 0.035 and 0.004 respectively). In contrast, clients accessing illegal services reported higher lifetime STI (36.0%, 95% confidence interval (CI) 20.2-55.6) than men recruited through private sex workers (20.0%, 95% CI 11.4-32.5) and clients from licenced brothels (7.6%, 95% CI 3.7-14.5). CONCLUSIONS This study found high self-reported lifetime prevalence of infection among sex workers and their clients. It is notable, however, that lower STI rates were reported by clients and sex workers from licenced brothels. This would suggest that risk of infection is not equivalent across industry sectors and highlights some of the inherent risks associated with generalisation across the sex industry.

Detection of Chlamydia trachomatis in an Australian High School student population

Objective: To assess the prevalence of Chlamydia trachomatis infections among an Australian high school adolescent population. Methods: Over a 4 year period, 14 high schools were selected in which an infertility prevention programme targeting C trachomatis was delivered to senior student populations. Coded first catch urine specimens were analysed by Amplicor PCR and infected students treated. Data retrospectively obtained from chlamydia screening programmes conducted among disadvantaged young people detached from formal education were also collated for comparison. Results: Of a total student test population of 1174, 15 (1.3%; 95% CI 0.7% to 2.1%) were diagnosed with C trachomatis. Of 516 females and 658 males, 12 (2.3%; 95% CI 1.1% to 4.1%) and 3 (0.5%; 95% CI 0.1% to 1.4%) were tested positive respectively. Data collated for three populations of disadvantaged youth returned at total of 89 C trachomatis infections out of 560 people (15.9% 95%CI 13.0–19.2%). Conclusion: The overall prevalence of C trachomatis infection among this population of senior high school adolescents is low, and significantly differs from the higher chlamydia rates detected in disadvantaged adolescents detached from formal schooling (p<0.0001).

Hepatitis B Knowledge, Testing, and Vaccination Among Chinese and Vietnamese Adults in Australia

Hepatitis B is a significant public health challenge within some subpopulations in Australia, including Chinese and Vietnamese migrants. There has been limited research on hepatitis B knowledge and actions in these communities. The authors conducted a self-administered survey among 442 Chinese and 433 Vietnamese in Brisbane. Generally, the knowledge is best described as “moderate.” One in 2 could not identify the sexual transmission risk and less than one third knew that sharing foods or drinks did not spread the disease. The majority of Vietnamese (80%) and 60% of Chinese respondents indicated prior testing. Vaccination was reported in 60% of the Vietnamese and in 52% of the Chinese. Knowledge was better among Chinese people who had been tested and vaccinated compared with those who were nontested and nonvaccinated. Only 3.5% of the Chinese, but 11.6% of the Vietnamese, indicated having a positive test result hepatitis B virus. This study helps identify strategies for programs targeting both communities and practitioners.

Screening for syphilis among men who have sex with men in various clinical settings

Objectives: To assess the prevalence of syphilis infections among men who have sex with men (MSM) accessing the Brisbane Sexual Health Clinic during the period 1997 up to May 2003, data were collated through three clinical programmes conducted by the service—a large inner city mainstream sexual health clinic and two small outreach sessional clinics conducted on the site of male sex on premises venues (SOPV). Data analysis also provided the opportunity to evaluate the effectiveness of the smaller outreach clinics to access populations of MSM less likely to attend or identify at the larger mainstream clinic, and therefore enhance the detection of previously undiagnosed sexually transmissible infections. Methods: Computerised records from 1997–2003 were collated for a statistical analysis of syphilis and other STI pathology results for all MSM accessing the mainstream clinic, and two outreach clinics. Results: A review of client charts showed that 16 new syphilis diagnoses were made over the previous 5 years, but only two of these infections (both through the mainstream clinic) were early syphilis and therefore transmissible. All other cases were latent infections. A higher proportion of bisexual men was identified with positive syphilis serology but this was just below significance (p = 0.06). Significantly, almost a third of syphilis diagnoses (all latent) were made at SOPV outreach clinics, despite the much lower proportion of clients seen overall through the SOPV clinics. For other sexually transmissible infections, the mainstream clinic demonstrated greater efficiency at case detection. Conclusion: Outreach clinics located in male saunas may serve an effective function in syphilis screening by facilitating access for a particular subpopulation of MSM (bisexual, married men). These outreach clinics may provide important outlets for education and opportunistic screening of asymptomatic MSM and foster a greater willingness for men to honestly self identify. However, larger, mainstream clinics serve a more anonymous venue for the testing of symptomatic men.

Sex on premises venue (SOPV) health promotion project in response to sustained increases in HIV notifications.

BACKGROUND Due to increases in HIV notifications in Queensland, a health promotion outreach project was developed with sex on premises venues (SOPV) in Brisbane. METHODS A health promotion officer (HPO) promoted safer sex behaviours among SOPV patrons over 14 months, including providing information, counselling and skills to enhance safer sexual behaviours and providing referrals. Surveys were introduced to facilitate discussions regarding HIV/sexually transmissible infections, testing and safer sex practices. RESULTS The project demonstrated feasibility within this highly sexualised environment, and was enhanced by careful monitoring and revising the procedure to improve patron/staff responses to the project. The introduction of a survey instrument was a significant contributor to the projects effectiveness, providing opportunities for patrons to discuss a variety of key sexual health issues. CONCLUSIONS This initiative reflected effective partnering between the Health Department, a community HIV/lesbian, gay, bisexual and transgender organisation and private industry. Despite initial difficulties, the presence of a health worker within an SOPV was acceptable to patrons and allowed for brief interventions to be conducted. This project was deemed effective for a limited time period and within certain constraints.

Interaction of microbiology and pathology in women undergoing investigations for infertility

BACKGROUND Cases of endometriosis with no tubal damage are associated with infertility, suggesting an immunological rather than mechanical barrier to reproduction. Laparoscopy and falloposcopy results of clinically asymptomatic women undergoing investigation of infertility were correlated with the outcomes of microbiological screening for Chlamydia trachomatis, Mycoplasma pneumoniae, Mycoplasma hominis, ureaplasma species, Neisseria gonorrhoeae, Neisseria meningitidis and Chlamydia pneumoniae. METHODS A total of 44 women presenting to a hospital IVF service for laparoscopic or laparoscopic/falloposcopic investigation of infertility provided endocervical swabs, fallopian tube washings, and peripheral whole blood for analysis. RESULTS Of these 44 women, 15.9% (7) showed evidence of C. trachomatis infection as detected by either PCR or EIA serology. Of these 7 women, 5 (71%) had no or mild endometriosis and 2 (29%) had moderate or severe endometriosis. Of the remaining 37 women who showed no evidence of chlamydial infection, 15 (40.5%) had no or mild endometriosis. CONCLUSION Women with infertility, but without severe endometriosis at laparoscopy, showed a trend towards tubal damage and a higher rate of previous C. trachomatis infection. Although not statistically significant, this trend would suggest that, where moderate to severe tubal damage is found to be the primary cause of infertility, C. trachomatis infection could be a likely cause for such tubal damage.